Progressive Care for those in Pain in Benton-Franklin CountyTri-City Pain Management Network

According to the Institute of Medicine

• Pain affects at least 116 million people (more than those affected by cancer, diabetes and heart disease combined)

• At an annual cost of $560-625 billion.

The Problem: Pain is the #1 public health issue

in the U.S.

The Problem• Opioids are not a panacea, or meant to

treat all pain, all of the time.

• In fact, opioids only reduce pain by about 30 to 35 percent in fewer than half of all patients.

• "Relieving Pain in America" report comes from the Institute of Medicine:A Blueprint for Transforming Prevention, Care, Education and Research."

The problem has grown dramatically

• Overdoses of prescription pain medication now kill nearly 15,000 people a year – more than heroin and cocaine combined.

• http://www.propublica.org/article/the-champion-of-painkillers/single

Overdose Death Rates by State, 2008 CDC

In Washington, the number of deaths from prescription overdose exceed those from car accidents for people 35-54 years old

From the head of the CDC:Overdoses from opioid drugs, like Oxycontin, are

at “epidemic” levels

And a growing group of experts doubts that these medications work for long-term pain.

So what is the solution?

http://www.cdc.gov/media/releases/2011/p1101_flu_pain_killer_overdose.html

Efforts by the State of Washington• Recently adopted new

standards of practice relating to pain management that apply to all physicians within the state.

• This is limiting access to pain medication in some cases.

TCPMN is a group with a vision for pain management that could help stem this problem in our region.

Neurosurgeon Anjan Sen, MD, was the driving force in creating this group in the 1990’s.

The Mission of TCPMN

The TCPMN is a non-profit community-based multi-disciplinary group of healthcare providers and community representatives working together to provide resources, services and education to the Tri-Cities and surrounding communities.

TCPMN vision, part 1

Identify the needs of healthcare providers, patients and families, and members of the community regarding pain management and community pain resources.

TCPMN vision, part 2

Develop and provide support services that include, but are not limited to, written materials, clinical expertise, and individual and group learning activities that reflect a holistic and multi-disciplinary approach to pain management.

TCPMN vision, part 3

Evaluate effectiveness of resources, services and education provided.

The Chronic Pain Resource Guide• Developed from a multi-group effort of :• TCPMN • Tri-Cities Cancer Center• Benton Franklin Health Alliance• Kadlec Neurologic Resource Center• And other private practices in the area

• United Way provided a grant to develop and distribute the Guide.

Our goal is to get this guide into the community with the message that there are powerful ways to change pain using many different methods.

Disciplines represented in the Guide:• Acupuncture Chiropractic• Counseling Massage• Medical Music Therapy• Physical Therapy And more

MassageGroup Health Research Institute of Seattle conducted a randomized controlled study of 401 chronic back pain patients.

• 3 Groups with 10 weeks of treatments: • Relaxation Massage, • Structural Massage,• Usual Care (drugs, PT, exercise, and education)

• Results: Both massage groups reported more effective pain relief and improvement in activities of daily living for up to 6 months.

• Annals of Internal Medicine, 07/05/2011

Chinese Medicine/ Acupuncture• Systematic Review of 25

RCT were identified with 1516 participants

• TCM therapies appear to be effective for treating fibromyalgia

• In addition, TCM is used in many pain conditions and disease processes.

• J Altern Complement Med. 2010 Apr;16(4):397-409. Traditional Chinese Medicine (TCM) for treatment of fibromyalgia: a systematic review of randomized controlled trials (RCT). Cao H, Liu J, Lewith GT.

Physical Therapy: “Rehabilitation Counselors”

PT’s are trained to do thorough evaluations and design individualized programs to address the causes of pain. Several studies show its effectiveness for various conditions. For example:

• Medicare patients who received physical therapy in the acute phase following an episode of low back pain were less likely to receive epidural steroid injections, lumbar surgery, or frequent physician office visits in the year following their initial physician visit as compared with patients who received physical therapist treatment later.

• Spine (Phila Pa 1976). 2012 Apr 20;37(9):775-82. Management patterns in acute low back pain:

the role of physical therapy. Gellhorn AC, Chan L, Martin B, Friedly J.

Chiropractic

Chiropractic manipulation has been demonstrated to provide pain relief compared to a sham manipulation.

Spine J. 2006 Mar-Apr;6(2):131-7. Epub 2006 Feb 3. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Santilli V, Beghi E, Finucci S.

A January 2012 study in the Annals of Internal Medicine demonstrate spinal manipulation to be superior to medication for reducing acute and chronic back pain

Ann Intern Med. 2012 Jan 3;156(1 Pt 1):1-10.Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial. Bronfort G, Evans R, Anderson AV, Svendsen KH, Bracha Y, Grimm RH.

Counseling for Pain Management• Counseling does not cure but

can help individuals cope with pain conditions.

• Several research studies

support the use of counseling in the management of conditions such as low back pain.

• Review of 6 high quality studies demonstrated behavioral treatment seems to be an effective treatment for patients with chronic low back pain

Spine (Phila Pa 1976). 2000 Oct 15;25(20):2688-99. Behavioral treatment for chronic low back pain: a systematic review within the framework of the Cochrane Back Review Group. van Tulder MW, Ostelo R, Vlaeyen JW, Linton SJ, Morley SJ, Assendelft WJ.

Music and Pain Management• Research has found that listening to music reduces the perception of

pain, as well as enhances the effects of analgesics, decreases pain, depression and disability, and promotes feelings of power. (AMTA)

• The music therapy protocol is designed to perform several functions:• Provides distraction and directs attention away from pain or anxiety• Provides musical stimulus for rhythmic breathing• Offers a rhythmic structure for systematic release of body tension

• Cueing positive visual imagery• Conditioning a deep relaxation response• Changing mood• Focusing on positive thoughts and feelings • Celebrating life

- Professor Suzanne Hanser, EdD, MT-BC, Berkley College of Music

Nutrition &Pain Management• Researchers conducted a survey by the Gallup organization from

2008 to 2010.• Compared to normal-weight people in the survey, people with• BMIs between 25 and 29 -- had about 20% more pain. • BMIs between 30 and 34 had about 68% more pain. • BMIs between 35 and 39 had 136% more pain• BMIs over 40 reported having 254% more pain.

• There is increasing evidence for the effects of nutrition on pain. • For instance, Omega-3, in doses of 3 grams or more per day, has

been found effective for those with rheumatoid arthritis, reducing morning stiffness and the number of joints that are tender or swollen, according to a review of the research on omega-3 fatty acids and health in American Family Physician.

Value of a Multi-disciplinary Approach to Pain Management

Some circumstances of pain are complex and people in this situation do well when they work with more than one professional simultaneously.

The TCPMN is collaborating to help with that process. We are here to offer resources in the management of chronic pain.

You Can Help• Share the Guide with others• “Good Health Begins With Me” (Benton Franklin Health

Alliance)

Thank you! Any Questions?